You have been booked for a

Repair of

HYDROCELE

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 This leaflet aims to give you information about your
operation, your stay in hospital and advice when you go home.
Some of the information may or may not apply to you. Feel
free to discuss any issues and questions you may have about
you surgery with the medical and nursing staff looking after
you.
HYDROCELE
A hydrocele is a collection of fluid in a sac in the
scrotum next to the testicle. The normal testis is surrounded by
a smooth protective tissue sac. It makes a small amount of
lubricating fluid to allow the testes to move freely. Excess of
fluid normally drains away into the veins of the scrotum. If the
balance is altered between the amount of fluid made, and the
amount that is drained, some fluid accumulates as hydrocele.
This will often cause the scrotum to look big or swollen. A
hydrocele can be on either one side or on both sides of the
scrotum.

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 WHAT CAUSES A HYDROCELE?
In Children
During pregnancy, the testicles in boy babies actually
grow inside the abdominal cavity, not in the scrotum. Four
months before birth, a tunnel formed by the smooth lining of
the intestinal cavity, pushes down into the scrotum. Between 1
and 2 months before birth, the testicle moves down through
this tunnel to be anchored in the scrotum. The tunnel should
close after the testicles move through it.

Sometimes when it seals off, some fluid is trapped

around the testicles of the scrotum. This trapped fluid is called
a non-communiating hydrocele. Sometimes the tunnel closes
down but does not completely. As a result, at times the fluid
can drip down and accumulate in the scrotum to cause it to
look bigger while at other times it can drain back into the
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abdominal cavity and thus make the scrotum look normal in
size. This is called a communicating hydrocele because there
is still a tunnels communicating between the belly and the
scrotum.
Distinguishing between a communicating and a non
communicating hydrocele is important since it may influence
the treatment recommended by the surgeon.

In Adults
Sometimes, and more commonly in older men,
inflammation, trauma of the testicle and epididymis or fluid or
blood can cause obstruction within
the spermatic cord. Occasionally a
hydrocele may be associated with
an inguinal hernia. Many occur for
no obvious reason.
A hydrocele results in a
painless, swollen scrotum, one or
both sides, that feels like a water filled balloon.
Diagnosis is confirmed by examination, ultrasound or
by transillumination (using a shining flashlight through the
swollen part of the scrotum. If the scrotum is full of clear fluid,
the scrotum will light up).

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 WHAT ELSE CAN CAUSE SCROTAL SWELLING BESIDES
HYDROCELES?
Certain medical treatments
Congestive heart failure
Epididymitis
Hernia
Injury
Orchitis
Surgery in the genital area
Testicular torsion
Varicocele
Testicular cancer
HOW IS A HYDROCELE TREATED?
Hydroceles are usually not dangerous. They are usually
only treated when they cause infection, discomfort or
embarrassment. The best treatment for the hydrocele is surgery.
Surgical repair or removal of the fluid filled sac is performed
through an incision in the scrotum under a general anaesthetic
to prevent further accumulation of fluid.
Benefits of surgery:
-Cosmetic
-Reduction of scrotal size
-Pain relief
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 WHAT ARE THE ALTERNATIVES TO THIS
PROCEDURE?
Leaving it alone can be an option
In adults, if the hydrocele causes no symptoms, one
option is simply to leave it alone. If it becomes larger or
troublesome, you can always change your mind and have
treatment.
For most patients less than a year of age, surgeons will
often recommend observing (just watching) non-
communication hydroceles. This is because many of these
hydroceles will go away on their own. However, if the
hydrocele fails to disappear by the time the child reaches his
first birthday then it is unlikely to do so. In this situation, the
child probably need an operation.
Drainage
The fluid can be drained
easily with a needle and
syringe. However, following
this procedure, it is common for the sac of the hydrocele to
refill with fluid within a few months. Draining now and then
may be suitable though, if you are not fit for surgery or if you
do not want an operation.

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 The risks associated to this procedure are: recurrence of
the hydrocele in 100% of the cases (the fluid builds up again in
a month or two), infection, haemorrhage and increase of
adhesions in the area that make more difficult and with more
chances of complications the surgical repair.

WHAT SHOULD I EXPECT BEFORE THE PROCEDURE?

You will usually be admitted on the same day as your
surgery. This minor surgery is done as a day case using general
anaesthesia with prompt recovery expected.
You will be asked not to eat or drink for 6 hours before
surgery and, immediately before the operation, you may be
given a pre-medication by the anaesthetist which will make
you dry-mouthed and pleasantly sleepy.
Please be sure to inform your Urologist in advance of
your surgery if you have any of the following:
-an artificial heart valve

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-a coronary artery stent
-a heart pacemaker of defibrillator
-an artificial joint
-an artificial blood vessel graft
-a neurosurgical shunt
-any other implanted foreign body
-a prescription for Warfarin, Aspirin or Clopidogrel (Plavix)
-a previous or current MRSA infection
-high risk of variant CJD (if you have received a corneal
transplant, a neurosurgical dural transplant or previous
injections of human-derived growth hormone).

HOW LONG WILL I BE IN HOSPITAL?

Your operation has been planned as a day case
procedure which means that you will be able to come into
hospital and be discharged late the same day. Depending on
their circumstances, some patients are admitted overnight.

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 BEFORE YOU COME INTO HOSPITAL
You will need to have a bath or shower. Please shave
your operation site before admission, or if you prefer we shave
you before surgery.
ADMISSION TO HOSPITAL
On arrival to hospital, you will need to book in at the
Admission desk. You will the be directed to the ward, to day
surgery or to the theatre; here you will meet your nurse and
other members of the team who will be looking after you. The
facilities and general routine of the ward would be explained to
you.
GETTING READY FOR THE OPERATION
The nurse who is admitting you will ask some routine
questions, about your general health, the medication you take
and any allergies you have. You will be seen by your surgeon
and anaesthetist. You will be asked to sign a consent form if
you have not already done so, to say that you understand what
you have come into hospital for and what the operation
involved. If you have any question, please ask.
You will be asked to put on a theatre gown. A nurse
will check that you have a wristband on with your name, and
that your documentation, consent is in order. (You will be

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asked the same questions by several staff en route to theatre,
these are all safety measures).
CONSENT AND RISKS
A consent form is a legal document, recognizing your
willingness to proceed with the intended treatment You are
required to sign a consent form for the operation once you fully
understand the reason for the operation and the risk involved.
All the operations have risks associated with them. All
risks should be discussed with your doctor. You should
understand the procedure and any available alternative
treatment discussed.
Your local doctor may also be able to answer your
question.

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 THE HYDROCELE REPAIR OPERATION
You will be anaesthetized and pain free. Either a full
general anaesthetic (where you will be asleep throughout the
procedure) or spinal anaesthetic (where you are awake but
unable to feel anything form the waist down) will be used. All
methods minimise pain; your anaesthetist will explain the pros
and cons of each type of anaesthetic to you.

IN CHILDREN
The repair involves making and incision just below the
belt line and dissecting down to the hole in the muscle layer.
The hydrocele lying is removed from the scrotum and any
communication with the belly cavity is closes with stiches. The
deeper tissues and skin are the sewn together with dissolvable

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sutures that are hidden under the skin so that there are no
stiches to be removed.
An incision is made just above the groin. The open
communication between the abdominal cavity and scrotum will
be repaired. The muscles are tightened to prevent a hernia. The
fluid is removed from the scrotum, and the incision is closed.
The stiches dissolve, no stiches have to be removed after
surgery.
IN ADULTS
An incision is made in the scrotum, the fluid is drained
and the hydrocele sack either everted or sewn up so that it
cannot re-form.

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 ARE THERE ANY SIDE EFFECTS
As with any medical treatment there are some potential
complications with hydrocelectomy. You should be reassured
that, although all these complications are well recognized, the
majority of patients do not suffer any problems after a
urological procedure.
COMMON ( GREATER THAN 1 IN 10)
Swelling of the scrotum lasting for several days
Seepage of yellowish fluid from the wound several days
after surgery
OCCASIONAL (BETWEEN 1 IN 10 AND 1 IN 50)
Blood collection around testes which resolves slowly or
requires surgical removal.
Possible infection of the incision or the testis requiring
further treatment with antibioitics or surgical drainage
RARE ( LESS THAN 1 IN 50)
Recurrence of fluid collection
Chronic pain in the testicle or scrotum
HOSPITAL-ACQUIRED INFECTION
Colonization with MRSA (0.9%- 1 in 110)
Clostridium difficile bowel infection (0.01% - 1 in
10,000)
MRSA bloodstream infection (0.02%- 1 in 5000)

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 The rates for hospital acquired infection may be greater
in high risk patients e.g. with long term drainage tubes, after
removal of the bladder for cancer, after previous infections,
after prolonged hospitalization or after multiple admissions.

AFTER YOUR OPERATION

You will wake up in the recovery room; here specially
trained nurses will monitor closely how you feel. On waking
you will have a small oxygen mask in place, this will help the
anaesthetic wear off. The nurses will check your blood pressure
and pulse and make sure that you are confortable. When the
doctors and nurses are happy with your condition you will be
taken back to the ward were you will be made comfortable and
can rest.
Refreshments will be offered as soon as is safe for you
to have these.

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 PAIN CONTROL
Expect some discomfort. You will have given strong
pain killing and/or local anaesthetic drug in theatre, which will
reduce pain for the first few hours. Your pain will be closely
monitored to ensure that is kept to a minimum. You will be
offered and given pain relief, as appropriate. You will be given
pain-killing tablets to take home, which you should tale as
directed. The doctor can give you some antibiotics to take for 5
days as directed.

WHAT SHOULD I EXPECT WHEN I GET HOME

When you leave hospital, you will be given a draft
discharge summary of your admission. This holds important
information about your inpatient stay and your operation. If
you need to call your GP for any reason or to attend another
hospital, please, take this summary with you to allow the
doctors to see details of your treatment. This is particularly
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important if you need to consult another doctor within a few
days of your discharge.
You must make sure that an adult can take you home in
a car or taxi. You will need to go home to rest; you must have
an adult stay with you for the first 24 hours after your
operation. You should not drink alcohol for a minimum of 48
hours after your operation.
Ice packs may be kept close to the areas for the first day
after surgery to reduce the swelling. You are advised to wear
close fitting underpants for support for a few weeks after
surgery.
After a hernia operation the patient will have some
pain. Many times this is controlled with over-the-counter pain
medicines, but it may be necessary to take prescription pain
medicine as directed by your surgeon. The child may need to
rest at home before returning to school for up to a week, and
will likely have to refrain from full strenuous activities for a
month.

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 It is advisable to wear supportive underpants or scrotal
support until the swelling and discomfort have settled.
You are advised to take 10-14 days off work and should
avoid any strenuous exercise or heavy lifting to allow wound
healing. Sexual intercourse is best avoided or 10 days or until
local discomfort has settled.
THE WOUND
The wound should be kept clean and dry for 24 hours.
Thereafter, if a dressing is in place, this can be removed
following a short bath or shower. Until this area, heals, do not
have lengthy baths or showers since this will encourage the
stiches to dissolve too quickly and my cause infection.
You will have dissolving stiches, which may begin to
come away after a few days but can take up to two weeks to
clear completely. If all is well you may shower the day after
your surgery. Pat the wound dry gently with a clean towel for
the first seven days or so. Thereafter you may treat the wound
normally. You should expect some swelling to the wound and
testicles, which may feel hard and there may be some bruising.
Wearing supporting underpants (slip type, tight and/or double)
will help to reduce swelling an ease discomfort.

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 OTHER IMPORTANT POINTS
Some lumpiness above or behind the testicle is common
following the procedure and is often permanent.
WHAT TO LOOK FOR
It may be several hours before you pass water. If you have any
difficulty, particularly if your bladder feels uncomfortable full
but you still cannot pass water, you should attend your local
Emergency Department.
If you suffer from excessive pain, excessive bruising or
excessive swelling of the testicles you should contact your own
GP or the department for advice or attend your local
Emergency Department.
THE FIRST FEW DAYS
Gently increase your activity over the first few days,
little and often you can do more each day.
You are encouraged to move and walk as this will help
prevent stiffness, soreness and help with your circulation and
minimize the risk of complications such as chest infection,
deep vein clots and clots to the lungs. Take painkillers to ease
any discomfort to enable you to mobilise.

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 WORK AND ACTIVITY
You can get sick note from the ward for the first week.
You will need to see your GP for any further seek notes. At
first, discomfort in the wound will prevent you from harming
yourself by lifting things that are too heavy. You can return to
normal activity when the pain has settled. Swelling of the
wound or testicle need not prevent normal activity (if its is not
severe). Sex will not harm you but may be painful in the first
week or two. You should be able to return to work after one or
two weeks.
DRIVING
You may drive as soon as you are confident that you
can do an emergency stop. One or two weeks is usual.
OUTPATIENT
You will not routinely be given and out-patients
appointment, but should you have any concerns or would like
some advice, please ring our office.

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If you develop any of the following:
- Big swelling and pain in the scrotum
- Fever, chills, sweats
- Worsening wound discomfort
- Haematoma in the area
NOTIFY THE UROLOGIST OR ATTEND TO THE
EMERGENCY DEPARTMENT

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